NCSBN - National Council of State Boards of Nursing Ethical and Legal Principles Questions and Answers — Questions and Answers
Question 1: A surgeon asks a nurse to witness a client's signature on a surgical consent form. The nurse enters the room, and the client states, "I'm not really sure what the doctor is going to do, but I trust him." What is the nurse's most appropriate legal and ethical action?
- Sign the form as a witness since the client is willing to proceed.
- Provide a detailed explanation of the surgical procedure to the client.
- Notify the surgeon that the client does not have informed consent. (Correct answer)
- Ask the client's family member to explain the procedure to the client.
Correct answer: Notify the surgeon that the client does not have informed consent.
The nurse's role in witnessing consent is to attest to the authenticity of the signature and the client's competency, not to provide the primary explanation of the procedure. If the client does not understand the procedure, they cannot provide informed consent. The nurse has a duty to act as a patient advocate and must notify the surgeon, who is legally responsible for explaining the procedure and ensuring the client is truly informed.
Question 2: Which of the following actions by a nurse would be a violation of the Health Insurance Portability and Accountability Act (HIPAA)?
- Giving a verbal report on a client's condition to the oncoming shift nurse.
- Looking up the lab results of a neighbor who is a client on another unit. (Correct answer)
- Informing the hospital pharmacist about a client's new medication allergy.
- Documenting a client's response to pain medication in the electronic health record.
Correct answer: Looking up the lab results of a neighbor who is a client on another unit.
Accessing a client's protected health information (PHI) without a legitimate, job-related reason ('need to know') is a clear violation of HIPAA's privacy rule. The other options describe permissible disclosures of PHI for the purposes of treatment, payment, or healthcare operations.
Question 3: A client with a terminal illness has a valid living will that explicitly refuses the use of mechanical ventilation. The client becomes unconscious and experiences respiratory failure. The client's distraught spouse demands that the healthcare team "do everything possible" to save the client. What is the nurse's primary legal responsibility?
- Follow the spouse's wishes, as they are the next of kin.
- Honor the client's wishes as stated in the living will. (Correct answer)
- Initiate mechanical ventilation and immediately request an ethics consultation.
- Inform the spouse that only the physician can make the final decision.
Correct answer: Honor the client's wishes as stated in the living will.
A living will is a legal advance directive that outlines a person's wishes for medical treatment when they are no longer able to communicate. It represents the client's autonomous decision and must be honored by the healthcare team, even if family members disagree.
Question 4: A nurse administers an incorrect dose of an antihypertensive medication. The client's blood pressure drops slightly but remains within a safe range, and the client experiences no adverse effects. Which essential element of professional negligence (malpractice) is missing in this scenario?
- Duty to the client
- Breach of duty
- Causation
- Damages or harm (Correct answer)
Correct answer: Damages or harm
For a malpractice claim to be successful, four elements must be proven: duty, breach of duty, causation, and damages (harm). In this case, although the nurse breached the standard of care (breach of duty), the client did not suffer any actual injury or harm. Therefore, the element of damages is missing.
Question 5: A nurse who consistently provides pain relief, repositions clients for comfort, and advocates for their nutritional needs is primarily demonstrating which ethical principle?
- Justice
- Beneficence (Correct answer)
- Autonomy
- Fidelity
Correct answer: Beneficence
Beneficence is the ethical principle of acting for the good and well-being of others. The nurse's actions are all aimed at promoting the client's welfare and doing good, which is the core of beneficence.
Question 6: While assessing a 7-year-old child admitted for an asthma exacerbation, the nurse observes multiple circular bruises in various stages of healing on the child's back. The parent states the child is clumsy and falls a lot. Which of the following actions is the nurse's priority legal responsibility?
- Ask the parent to provide a more detailed history of the injuries.
- Report the suspicion of abuse to the appropriate authorities. (Correct answer)
- Carefully document the findings in the child's medical record only.
- Confront the parent about the inconsistencies in their story.
Correct answer: Report the suspicion of abuse to the appropriate authorities.
Nurses are mandated reporters. When there is a reasonable suspicion of child abuse (e.g., injuries inconsistent with the explanation, specific patterns of bruising), the nurse has a legal and ethical duty to report these concerns to Child Protective Services or law enforcement, depending on state law and facility policy.
NCSBN - National Council of State Boards of Nursing Ethical and Legal Principles Questions and Answers
A surgeon asks a nurse to witness a client's signature on a surgical consent form.
The nurse enters the room, and the client states, "I'm not really sure what the doctor is going to do, but I trust him." What is the nurse's most appropriate legal and ethical action?